Law & Ethics chapter 3

Licensure

A mandatory credentialing process established by law, usually at the state level, that grants the right to practice certain skills and endeavors

Reciprocity

The process by which a professional license obtained in one state may be accepted as valid in other states by prior agreement without reexamination

Certification

A voluntary credentailing process whereby applicants who meet specific requirements may receive a certificate

Registration

A credentialing procedure whereby others name is listed on a register as having paid a fee and or met certain criteria within a profession

Scope of practice

The determination of the duties/procedures that a person may or may not perform under the auspices of a specific health care professionals license

Accreditation

Official authorization of approval for confirming to a specified standard for health care education programs, health care facilities and managed care facilities

Medical practice acts

State laws written for the express purpose of governing the practice of medicine

Medical boards

Bodies established by the authority of each states medical practice acts for the purpose of protecting the health, safety, and welfare of health care consumers through proper licensing and regulation of physicians and others health care practitioners

Professional corporation

A body formed and authorized by law to act as a single person

Managed care organization

A corporation that links health care financing, administration, and service delivery

Managed care

A system in which financing, administration, and delivery of health care are combined to provide medical services to subscribers for a prepaid fee

Health maintenance organization

A health plan that combines coverage of health care costs and delivery of health care for a specific payment

Preferred provider organization (PPO)

A network of independent physicians, hospital, and other health care providers who contract with an insurance carrier to provide medical care at a discount rate to patients who are part of the insurers plan.

Physicians hospital organization (PHO)

A health care plan in which physicians join with hospitals to provide a medical care delivery system and then contract for insurance with a commercial carrier or an HMO

Medical services organization

A physician group purchased a hospital, in which then contracts with employers to provide full health care services

Exclusive provider organization (EPO)

A managed care plan that pays for health care services only within the plans network of physicians, specialist and hospital

Health savings account (HSA)

Offered to individuals covered by high deductible health plans, these accounts let these individuals save money, tax free, to pay for medical expenses

Independent practice association (IPA)

A type of HMO that counted ya with groups of physicians who practice in their own offices and evict a prememeber payment from participating HMOs to provide a full range of health services for members

Primary care physicians (PCP)

The physician responsible for directing all of a patients medical care and determining whether the patient should be referred for specialty care

Health insurance portability and accountability act (HIPAA)

A ferderal statue that helps workers keep continuous health coverage for themselves and their dependents when they change jobs, protects confidential medical information from unauthorized disclosure or use and helps curb the rising cost of fraud and abuse

Patient protection and affordable care act (PPACA)

A federal law enacted in 2010 to expand health insurance coverage and otherwise regulate the health insurance industry

Health care education and reconciliation act (HCERA)

Also enacted in 2010, a federal law that added to regulations imposed on the insurance by PPACA

Accountable care organization (ACO)

A health care payment and delievery model they rewards doctors and hospitals for controlling costs and improving outcomes by allowing them to keep a portion of the savings of standards of quality are met.